Gotham Gazette Gotham Gazette

Gotham Gazette

The Place for New York Policy and politics

Citizens Union

You're on an older version of the site, please click here to view the current site

Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 8 million residents--roughly 2 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz


In the age of AIDS, syphilis, which is curable in its early stages with a single dose of penicillin, might look like a minor threat. But this sexually-transmitted disease is often a harbinger of increased HIV infection rates--since the same practices transmit both illnesses. New York City has just seen the number of reported syphilis cases more than double between 2000 and 2001, from 117-282 and continue to increase dramatically in 2002. The research was published in the Center for Disease Control's bluntly-titled publication, Morbidity and Mortality Weekly Report.

"What we may be seeing is a herald of a big increase in HIV infection." says Dr. Susan Blank, Assistant Commissioner for Sexually Transmitted Disease Control at the city Department of Health and Mental Health and an author of the report. Syphilis cases had hit a peak of 5,000 annually in 1988, dropping to just 82 in 1998. But in the last few years, the numbers have increased again sharply. Worse, HIV and syphilis are synergistic -- each increasing the odds that the other will be transmitted. "Some studies have found that a syphilitic ulcer increases the risk of HIV transmission by up to five-fold," says Blank. While syphilis can occur with few symptoms and can be transmitted even if there are no obvious signs, the disease usually begins with the appearance of an ulcer, called a chancre, on the part of the body where the organism that causes the disease entered the body. These sores mainly affect the external genitalia, but they can also occur on the lips, in the mouth or on the hands.

Syphilis can be spread by vaginal, anal or oral sex -- or even by kissing if there are sores in the mouth.

Since the chancres do not hurt, they may go unnoticed. After about three to six weeks, they heal even without treatment and the secondary stage of the disease begins. This is marked by a rash (contact with this may also spread the bacteria), fever, sore throat, swollen lymph glands, headaches, muscle pains and tiredness.

Unless penicillin or other antibiotics are given, the disease can progress into the third stage. Though the infection may remain "silent" for years, late stage syphilis can eventually lead to nerve damage, liver and heart damage, paralysis, blindness, dementia and death. In pregnant women, it can cause stillbirth or can severely harm the newborn.

The recent outbreak has mainly affected gay and bisexual men--with 93% of cases occurring in males, 80% of whom reported male sex partners. The infected men interviewed by the health department had "multiple, multiple" partners, according to Blank, and many could not name them. About 1/3 said they met their partners at bars or clubs, but Blank doesn't see the clubs as the main cause of the problem.

In fact, they may be a symptom. The increased visibility of sex clubs following the end of Mayor Giuliani's term in office, "could be due to a re-emergence of unsafe behavior which occurs in a variety of venues" she says. A similar syphilis outbreak in San Francisco preceded an increase in HIV infections in the gay community, following years of declines. And frighteningly, in the New York City cases, nearly half of the men who were infected with syphilis were HIV-positive, so they could have either transmitted or been infected with HIV during the encounter in which they contracted the syphilis.

Gay Men's Health Crisis, which just opened a new program called the Institute for Gay Men's Health, has begun to provide testing for syphilis as well as the HIV testing it usually offers. "In some sense, we are victims of our own success," says Marty Algaze, director of communications for GMHC. "Because we have been able to get the pharmaceutical industry to create new medications that can help keep people alive, though they are not a cure, people are not dying in the numbers that they were in the 80's and early 90's. There is a whole generation of young people who didn't see people they know get sick and die."

Health Commissioner Thomas Frieden put it even more bluntly in a speech this summer to the city's HIV Prevention Planning Council. "Unfortunately, the thing that changes risk behavior most is for you to see a lot of your friends die. Lots of us have seen lots of our friends die. But the young community that is growing up has not seen it, by and large. And that means our prevention messages need to be much stronger, much more effective and frankly, I'm not sure how we can do it. Because other than seeing a bunch of your friends die, we have not seen anything that has made a massive change in sexual behavior in any country."

Nonetheless, the health department is redoubling its efforts, running an ad campaign aimed at gay men called "Syphilis is Back" and another called "Bring Your Own Condom" to promote safer sex in communities of color. Hours at free, confidential sexually-transmitted disease clinics have been extended. The department is also focusing on health care providers, trying to get physicians to take sexual histories in a nonjudgmental way to promote maximum honesty.

About half of the new cases occurred amongst people who saw private doctors, rather than visiting public clinics. "The perception is that syphilis is something that happens to poor people in the rural South," says Blank, adding that one of the health department's aims is to change this view amongst those at risk.

The department will also work with the CDC on a study which will compare gay men who contract syphilis with those who do not, in an effort to pinpoint precisely which men are at most risk and target them in prevention campaigns.

And there is at least one hopeful sign: an aggressive campaign of outreach, promoting testing and condom use by the Baltimore Department of Public health seems to have slowed a recent syphilis outbreak in that city. There were 26 cases there in the first half of this year, but none last month.

Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.

Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

Visit the Topic Archives!

Gotham Gazette the Place for Politics and Policy

Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

$app = JFactory::getApplication(); $menu = $app->getMenu(); $menu_items = $menu->getItems('menutype', 'mainmenu'); var_dump($menu_items); * */ ?>